Related Practices
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Covington advises and represents hospitals, health plans and other health care providers on issues involving reimbursement in the Medicare and Medicaid programs. Because we have a broad practice representing state agencies in the Medicaid area, we have a deep-rooted understanding in the structure and operations of these programs that enable us to develop workable solutions to difficult problems. Whether we are providing advice, working legislatively, or negotiating with the Centers for Medicare & Medicaid Services (“CMS”), we have the knowledge, skills, and expertise to assist providers in navigating the intricacies of Medicare and Medicaid reimbursement, particularly the complex areas where the two intersect. We have advised hospitals and health plans on federal rules and policy governing intergovernmental transfers, certified public expenditures, provider taxes, Medicare bad debt for dual eligibles, upper payment limits, Medicare and Medicaid disproportionate share payments, and reimbursement for graduate medical education. In disputes between providers and their Medicare fiscal intermediaries, we have appeared before the HHS Provider Reimbursement Review Board and in court.
Representative Matters
- We have worked with a number of state hospital associations to help develop new Medicaid reimbursement structures to respond to CMS policy on intergovernmental transfers and certified public expenditures.
- We represented a cancer hospital in a challenge before the PRRB and federal district court to increase the hospital’s graduate medical education reimbursement from Medicare. The federal court ordered CMS to pay the hospital an additional $4.5 million, reflecting increased GME payments over 10 years.
- We developed a position paper which a hospital successfully used with its fiscal intermediary to include long-term Medicaid patients on its ventilator-dependent unit in its Medicare disproportionate share calculation.
- We advise a coalition of Boston teaching hospitals with regard to Medicare Indirect Medical Education (IME) payment matters. We have assisted our clients in their successful opposition to congressionally mandated reductions in Medicare spending on teaching hospitals.
Accolades
- PLC Cross-border Super League
- Ranked 1st in the Life Sciences Regulatory Super League (2004-2011)
- Ranked 1st in the Life Sciences Industry Super League (2005-2009)
- PLC - Life Sciences, Which Law Firm? (2012)
- Leading: Regulatory firm, Belgium, England, EU, and USA
- Leading: Commercial & Partnering, Government Enforcement & Investigations, USA
- Leading: Competition/Antitrust, EU
- Highly Recommended: Corporate, Product Liability, USA
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